MONTHLY REPORT OF OPERATIONS PERFORMED AT THE METROPOLITAN HOSPITALS.

ON A

A Mirror

NEW MODE OF EFFECTING ARTIFICIAL RESPIRATION. BY MARSHALL

OF THE PRACTICE OF

MEDICINE

HALL, M.D., F.R.S.,

MEMBER OF THE INSTITUTE OF

two the Eclitor

FRANCE, ETC.

of THl; LANCET.

SIR,-The following document

AND

’

cannot fail to interest your

HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum et dissectionum historias, tam aliorum proprias, collectas habere et inter se comparare.—MORGAGNI. De Sed. et Caus. Morb. lib. 14. Proœmium.

readers.

Artificial respiration is the sine quâ non of our treatment of suspended animal animation by drowning, strangulation, &c., and the only efficient mode of accomplishing it is, I believe,

MONTHLY REPORT

that here described.

OF

OPERATIONS PERFORMED AT THE METROPOLITAN HOSPITALS.

"attended at St. GeoTge’s Hospital, to witness some expenithe new method of producing artificial made
The mouth and

one

nostril

GUY’S HOSPITAL.

carefully closed by means possibility of air finding its

were

THE return for the month, sent to us by Mr. WaHace, the house-surgeon of Guy’s Hospital, shows that during the time between the 1st and 31st of January, there were twenty-two

sticking-plaster, to prevent the through them. In the other nostril was inserted a caoutchouc tube, about three feet long, at the end of which operations. was fixed a bent glass tube of the same size, into which was a of water. poured teaspoonful

.of

SURGERY

IN THE

way

AMPUTATIONS.

CASE I.-A man of cachectic constitution, aged forty-six, " The operator then took hold of the subject (which was lying in the prone position) by the left shoulder and hip, and with compound fracture of the tibia and fibula, at the junction gently raised it, until the whole body was resting on the right of the middle and lower third. On the 3rd of January, Mr. side. This movement caused the air to enter the glass tube, Cock performed amputation below the knee, the skin having creating bubbles in the water as it passed on into the lungs; ulcerated, and the soft part sloughed. The patient died five and on the body being slowly replaced on the stomach, the air days after amputation, and twelve days after injury. CASE 2.-Primary amputation of the humerus, about three was freely expelled from the lungs, and caused the same inches below the shoulder, by Mr. Poland. The patient, a in the the water as it made its exit agitation through glass male aged forty-seven, had suffered extensive injuries. The tube. arm was only attached to the trunk by a small portion of " Judging from the agitation of the water, the quantity of muscle, skin, and nerves, and some vessels which were unair which passed into the lungs must have been considerable, injured. He was found, also, to have dislocation of the left hip; fracture of eleven ribs on the left side, and four on the .and quite sufficient for the purpose of artificial respiration. "The great advantage of inflating the lungs by means of the ’, right; and partial dislocation of the tibia of the right extremity with rupture of posterior and external ligaments, rotatory movement, or raising the body by the one shoulder ’, backwards, and fracture of the upper part of the fibula, which was drawn and hip, is the readiness with which one person can perform up by the biceps. He died three days after the operation. the operation, in the absence of any other assistance. CASE 3.-A man, aged twenty-eight, with ununited fracture of the tibia and fibula. The ends of the bones had been for "This experiment appeared to be perfectly satisfactory. "The other method was then tried, by raising the subject some time previously sawn off, for the purpose of inviting reunion. On the 15th of Mr. Birkett performed ampuby the two shoulders, until the stomach was freed from any tation below the knee. January, The patient is recovering. pressure, on the table, and then gently lowered down again. CASE 4.-A man, aged fifty-eight, with compound fracture This movement produced precisely the same results as the of radius and ulna. Attempts, that were of no avail, were made to save the upper arm. Extensive sloughing and rotatory, but required more strength to perform it. "HERBERT WILLIAMS, gangrene having appeared, Mr. Birkett, on the 17th of January, (three weeks after the injury,) performed amputation "Feb. 6th, 1856." Superintendent R.H.S., Hydeat the upper third of the humerus. The patient died six days park Receiving-house. after the operation. In the szcpine position, the tongue falls backwards, and CASE 5.-A female, aged twenty, with malignant disease closes the glottis. All inspiration is therefore impossible. below the knee. The malignant growth had been twice reIn the prone position, the tongue falls forwards, and leaves moved, but had returned. On the 20th of January, Mr. Birkett performed amputation above the knee. After the operation, the glottis freely patent. Inspiration is therefore possible. sloughing of the soft parts took place, so that two inches of Respiration is effected by placing the patient in the prone bone are now left protruding. Patient recovering. position, and turning on the side fully, and rather more, alterCASE 6.-A female, aged fifty-three, with diseased kneenately. In the former position, pressure is made on the thorax joint of three years’ duration. Mr. Hilton performed amputaand abdomen equal to the weight of the body, and expiration tion above the knee. Patient recovering. takes place. In the latter, that pressure is removed, and i2zHERNIA. spiration occurs. CASE 1.—A female, aged sixty-five, with strangulated These movements being made alternately, gently and equably, umbilical hernia. Strangulation had existed for five days. sixteen times a minute, and no more, respiratio-i is efficiently On the 26th of January, Mr. Callaway performed herniotomy. performed, and this without bellows, syringe, or any apparatus, The patient died twenty-four hours after the operation. The ’

all of which are not only unnecessary, but, for reasons which cannot now be detailed, dangerous. I trust soon to send you a fuller set of Nezv Rules for the Treatment of Asphyxia. In the meantime, this short communication may not be without its utility. I am, Sir, your obedient servant, .Princes-street, Hanover-square, MARSHALL HALL. Feb. 20th, 1856.

intestine was gangrenous. CASE 2.-A female, aged eighty-one, with strangulated ’ had existed twelve hours. On inguinal hernia. the 30th of January, Mr. Callaway performed herniotomy, the patient dying two days after the operation. CASE 3.-A female, aged forty-five, with strangulated femoral hernia, that had existed seventy-two hours. On the 31st of January, herniotomy was performed by Mr. Birkett. The bowel was returned without the sac being opened.

Strangulation

229

The

tomy

patient was a male, aged four years and a half. Lithoperformed by Mr. Cock on the 29th of January, and

was

stone about the size of done well. a

a

bean

was

extracted.

of the most eminent surgical instrument-maker of soon convinced that the delicately minute lithotrites there in use might be relied on for strength. But, perhaps, those who dislike the performance of lithotrity in children do not argue so much from any supposed instrumental difficulty in its performance, as from the unquestionable fact that it has not, as regards immunity from peril, that superiority to lithotomy which it possesses in adult cases. Themortality following lithotomy may be stated, in round num. bers, as one in fifteen in children, and one in five or six in adults; and from lithotrity, as performed in suitable cases, the deaths are as near as may be in the proportion of one to fifteen. The inducement, therefore, to change our practice, and place crushing before cutting, may appear to be slight, still, whenever we have seen the performance of lithotomy result in the removal of a concretion either not bigger or smaller than a pea, we have always felt that a preliminary attempt to crush would have been a more fit course of procedure. Why should not a small lithotrite be used for the purpose of sounding ? A better sound, most surgeons say, it is impossible ta employ; and, then, if so minute a calculus be detected, why should it not be crushed at a single sitting ? the

CALCULUS VESICLE.

The

case

has

URETHRAL STRICTURE.

patient, aged thirty-three, was suffering from perineal fistula as well as stricture. Syme’s operation was performed by Mr. Birkett on the 22nd of January. The case was most The

satisfactory. RETENTION AND EXTRAVASATION OF URINE.

The

patient, a boy aged fourteen, ruptured his urethra by falling on the edge of a table. Extravasation had existed for three days, when Mr. Birkett, on the llth of January, performed perineal section. The patient has recovered. EXCISION OF NECROSED BONE.

CASE 1.—A male, aged nineteen. Mr. Cock removed portions of the third and fourth metacarpal bones, and also the unciform and os magnum. CASE 2.-A male, aged seven, from whom Mr. Hilton removed a piece of necrosed bone from the upper part of the tibia. The patient had been operated upon for the same purpose, but lower down the leg, five months before. The duration of the disease, two years and a half. CASE 3.-A female, aged nineteen, from whom Mr. Hilton removed a portion of necrosed bone at about the middle of the tibia. There was no trace of injury or syphilis in the patient. She had been operated on before by Mr. Hilton. CASE 4.-A female, aged fifteen, of a very strumous constitution. Mr. Birkett removed a piece of necrosed bone from the ulna. CASE 5.-A male, aged twenty-seven, who had received a severe kick from a horse eleven weeks ago. Mr. Hilton removed a portion of the squamous part of the left temporal bone. All the above cases did, or are doing, well.

wares

France, and were

ST. MARY’S HOSPITAL. THE

which occurred during January Mary’s Hospital, we give from the of Mr. G. G. Gascoyne, the house-surgeon :-

present

following

cases,

year in St.

of the return

URETHRAL STRICTURE.

The patient, a man aged fifty, had for many months experienced great difficulty in micturition, which rapidly increased, until at last his urine flowed guttatim. The seat of

the stricture was between two and three inches from the orifice of the urethra, and so exceedingly firm and dense was it that its nature was suspected to be scirrhous. The man had lost a portion of the glans penis about the orifice twenty years ago, from syphilitic ulceration. Mr. Lane passed an armed stilette down to the point of obstruction, and cut through the stricture. OPERATIONS FOR REMOVAL OF TUMOURS. A piece of bougie was then introduced, and kept there. The CASE 1.—A female, aged forty-eight, with eight sebaceous patient now passes his urine in a fair stream, and without any tumours, of various sizes, between the magnitude of a sparrow’s inconvenience; there is, ltou;ezea-, much thickening about the egg and a tennis-ball, situated about the head and back. The seat of the stricture. This case, now that the comparative growths had existed for twenty years. Mr. Birkett removed merits of external and internal divisions of stricture are so them all at one time of operating. The woman recovered very much under discussion, cannot fail to attract attention. The quickly. only comment we feel it necessary to make on the case, is CASE 2.-A woman, aged twenty-seven, from whom, on found in the emphasis we have laid on the last words, announcing January 22nd, Mr. Cock removed one of Mr. Paget’s myeloid the result of the treatment. tumours, together with the spine of the scapula, acromion proINGUINAL HERNIA. cess, and end of clavicle. She is recovering rapidly. CASE 3.-A female, aged fifty-eight, from whom Mr. Birkett The patient was a man aged eighty-six, with a hernia of removed a cancerous tumour from the breast. The patient is forty years’ duration, that came down under the truss six days recovering. before his admission into the hospital. For three days there TRACHEOTOMY. had been no action of the bowels, and then slight stercoraceous Mr. Callaway, on January 28th, performed tracheotomy on vomiting and constitutional symptoms displayed themselves. As the heart’s action was very feeble and intermittent, no a man, aged thirty-two, with syphilitic sore-throat, extending to the larynx. Death occurred three days after the operation. chloroform was given before Mr. Walton performed the usual operations. The peritoneum was very much thickened, and more than half a pint of fluid was in the sac. The bowels were (ESOPHAGOTOMY. Performed by Mr. Cock. This case has already been re- congested, but not to a great extent. Return was prevented by adhesion between the intestine and peritoneum at the neck ported at full in our columns. of the sac. A piece of the ileum, but no omentum, was found The first case mentioned in the above abstract may be here in the sac, about fourteen inches from the caecum. Death observed upon in comparison with one in which lithotomy was from shock followed in sixty-four hours after the operation. performed by Mr. Cock, in the theatre of Guy’s Hospital, on REMOVAL OF A DEAD PORTION OF THE RIGHT February 12th last. In the latter case, the patient was a boy, TEVIPORAL BONE. a who had and suffered two half, years excruciating pain aged The patient, a young man aged twenty-eight years, about from the presence of a stone in the bladder. The child was placed under the influence of chloroform, and after the per- twelve years ago received a blow on the right temple, ever formance of the customary operation, a minute calculus, about since which accident he had been subject to severe headaches. half the size of a pea, and grooved like a coffee-berry, was ex- Six years from the present time he had a fit, and at the end of tracted. The case, as is usual with young subjects, has done two years he had another. These fits now became frequent, well, and therefore it offers no especial argument against the till three years ago, when a swelling came on over the temple, practice that prevails in our own country-namely, of having which was opened, and dead bone detected. He was conserecourse to lithotomy, in preference to lithotrity, in the treatquently trephined. This occurred in America. After the ment of children afflicted with stone in the bladder. The! operation, the fits ceased, but the opening that had been made exact reverse is the rule in Paris, the mechanicians of which never healed, and at the time of his admission into St. Mary’s capital have practically displayed the unreasonable character Hospital was discharging profusely. He complained of intense of the fearsof those who apprehended that no lithotrite could headaehe, and was getting into a very low condition. Mr. be made of the requisite smallness, and at the same time off Coulson, seeing that no relief could be obtained till the cause the requisite strength, for its secure use in crushing stone inLof mischief had been removed, divided the integument over children. When last in Paris, we had ample opportunities9 the right temple, and took away a piece of loose dead bone, for examining the productions and testing the capabilities off two inches long by three. quarters of an inch wide. The .

’

230

wound is

granulating beautifully from the bottom, and the edges are cicatrizing. The pulsation of the brain is distinctly The patient’s general health is much improved, and he seen. does not suffer from headache.

OPERATIONS ON THE EYE AND EYELIDS.

CASE l.-The patient, a boy aged fourteen years, had a small fatty tumour on the back of the upper eyelid, towards the outer canthus. The growth had been observed for some months, but had caused irritation only for a brief space of time. It was about the size of a large pea. Mr. White Cooper removed it. CASE 2. -The patient was a male child, aged two years, with a small encysted tumour between the orbit and globe of the eye, just below the lachrymal gland. It was as large as a small horse-bean, and of the same shape, with the end protruding forwards. Mr. Spencer White removed it, but experienced considerable difficulty in doing so, owing to the growth extending so far back into the cavity of the orbit, and adhering

Medical Societies. ROYAL

CHIRURGICAL SOCIETY. TUESDAY, FEB. 12TH, 1856. MR. CÆSAR HAWKINS, PRESIDENT, IN THE CHAIR. MEDICAL &

CHEMICAL EXAMINATION OF THE EXCRETIONS IN A FATAL CASE OF OBSTRUCTION OF BOTH URETERS BY CALCULI. BY PROFESSOR

MAYER,

OF MADRAS.

(Commuaicated by M.D., F.R.S.) THE paper, to which Professor Mayor’s experiments formed an appendix, described at great length the case of a clergyman who died in India, having both ureters almost completely obstructed : death took place on the eighteenth day from the commencement of the symptoms, and during that period only to the periosteum. The operation was followed by a severe six ounces, two drachms, and twelve minims offluid, including attack of erysipelas, from which the patient has recovered. pus and blood, were passed per urethram. The object of the He is now doing well. experiments of Professor Mayer was -to ascertain the presence or absence in the excretions of certain matters, more especially CONTRACTED KNEE-JOINT. of urea, with a view to the formation of correct ideas as to the A female of the middle age of life was taken into the hos- nature, severity, and progress of the disease. The results were, pital with contraction of both the knee-joints, that effectually that pus in large quantity, albumen, and urea, were found to crippled and made life a burden to her. The hamstring tendons be present in the fluid passed per urethram. In the matters felt very tense beneath the skin, and the knees were in the passed per anum, animal salts were present in excess, and the semi-flexed position. The contraction came on soon after a author considered ita fair inference that a portion of these represevere attack of rheumatic fever, followed by sloughs. Mr. sented decomposed uret. The examination of the matters passed Walton has commenced the treatment by effecting the division off by the lungs was not satisfactory for proof of more than the of the biceps and semi-membranosus tendons of the left limb fact, that, in this case at least, urea. did not pass off in any by subcutaneous incisions in the popliteal space. The knee appreciable quantity, in the form of ammoniacal salts from the was fully extended after the operation, and the case is progresslungs. In the perspiration, uric acid was distinctly found. ing satisfactorily in every respect. The calculi were minutely examined and described as uric acid calculi, containing varying amounts of urates and phosphates. The right kidney contained one large calculus; the left, one MIDDLESEX HOSPITAL. and four smaller ones. large DURING the month of January there was not much of any Dr. BENCE JOXES said he had brought the paper before the unusual interest in the wards of this institution, the cases, Society because he considered the experiments detailed in it with but few exceptions, being devoid of any features uncomperfectly trustworthy. He had never before seen a case of the mon in hospital practice. The following cases, however, de- kind in which the presence of uric acid in the perspiration had serve brief mention, in making which we avail ourselves of the been positively established. The latest experiments had not notes of Mr. Joshua Plaskett, the house-surgeon :detected its presence in healthy subjects. The PRESIDENT asked Dr. Jones if he had ever examined AMPUTATION OF THE THIGH. the perspiration in cases of retention of urine, as from stricThe patient, a man aged forty-one, was labouring under the ture : in such cases the smell of the skin was sometimes strongly consequences of syphilis, a secondary syphilitic ulcer having urinary. Dr. JoNES had never made any satisfactory examinations of opened into the knee-joint and exposed the head of the tibia, which was in a carious condition. The treatment first had the kind referred to; but he did not, however, consider that recourse to was that of enlarging the opening leading into the the urinous smell was due to uric acid, but to some more volajoint, and applying the actual cautery liberally over the knee; tile substance. But these measures produced no beneficial results. The severity Dr. GAPROD said it had been alleged that the white powder of the local inflammation, together with constitutional sym- observable on the skin in gouty patients contained uric acid, pathy, overcame the strength of the patient, who daily was but the statement had not been satisfactorily proved. In cases Under these circum- of chronic gout, in which the blood contained a large amount seen to be sinking from bad to worse. stances, it was determined to sacrifice the limb to the chance of uric acid in the form of urate of soda, he had been unable, of saving the man’s life. Mr. Moore therefore amputated the after very careful experiments, to find a single trace of the thigh, at about the middle, by the circular operation. The acid in the perspiration. He considered that the experiments patient bore the operation well, and has ever since been pro- would require confirmation before it could be considered as established that the skin eliminated uric acid when the kidneys gressing favourably. could not perform their duty. EXCISION OF THE ELBOW-JOINT. Dr. JONES referred to the swellings in the psoas muscle The patient, a woman aged thirty-one, had suffered for two alluded to by the author, and said he had observed similar years under strumous disease of the joint. The case was one appearances in a case of obstruction of the ureter. He found, that imperatively called for decisive treatment. The affected on a post-mortem examination, that the swelling perceptible joint therefore was excised by Mr. Moore, who operated by during life in the lumbar region was not due to a distension of making a, single longitudinal incision. Rather more than an the kidney, but to inflammation outside the kidneys involving inch was removed from the ulna and radius, and a triangular the psoas muscle, passing upwards to the diaphragm, and down piece was taken away from between the condyles of the humerus, into the pelvis. those processes being left entire. The patient still remains in Dr. SNOW said he had observed the same appearance in two the hospital, but the case has progressed most favourably, the who had died of calculi in the kidney. He also menpatients wound filling up rapidly, and there being every promise that a tioned a case in which he had detected ammonia in the breath useful arm will be obtained. To this case the remarks that we of a patient suffering from congestion of the kidneys and albumade last week on resections and excisions forcibly apply. minuria. REMOVAL OF THE BREAST.

The patient, a woman aged fifty, had suffered from scirrhous disease of the breast for three years. The skin was not ulcerated, and the lymphatics were unaffected. On the whole, it was a case in which benefit from excision might be anticiof the inpated. The whole gland, together with an teguments was removed. The patient left the hospital with the wound firmly healed.

ellipse

R. BENCE JONES,

REPORTS OF CASES ILLUSTRATIVE OF THE PATHOLOGY OF THE EAR. BY JAMES

HINTON, ESQ., M.R.C.S.

(Communicated by ls. STANLEY.) The paper described the results of 56 dissections of the ear, made by the author. Of these 56 cases, 12 were healthy. Of the remaining 44, which deviated more or less from health, 7 belonged to persons known to be deaf, 9 to persons who had

231